Characteristics of Adults Who Use Prayer as an Alternative Therapy

Purpose: To describe the demographics, health-related and preventive-health behaviors, health status, and health care charges of adults who do and do not pray for health. Design: Cross-sectional survey with 1-year follow-up. Setting: A Minnesota health plan. Subjects: A stratified random sample of 5107 members age 40 and over with analysis based on 4404 survey respondents (86%). Measures: Survey data included health risks, health practices, use of preventive health services, satisfaction with care, and use of alternative therapies. Health care charges were obtained from administrative data. Results: Overall, 47.2% of study subjects reported that they pray for health, and 90.3% of these believed prayer improved their health. After adjustment for demographics, those who pray had significantly less smoking and alcohol use and more preventive care visits, influenza immunizations, vegetable intake, satisfaction with care, and social support and were more likely to have a regular primary care provider. Rates of functional impairment, depressive symptoms, chronic diseases, and total health care charges were not related to prayer. Conclusions: Those who pray had more favorable health-related behaviors, preventive service use, and satisfaction with care. Discussion of prayer could help guide customization of clinical care. Research that examines the effect of prayer on health status should adjust for variables related both to use of prayer and to health status

Goals of Fecal Incontinence Management Identified by Community-Living Incontinent Adults

The purpose of this study was to identify goals of fecal incontinence (FI) management and their importance to community-living adults if complete continence would not be possible. Participants expressed their goals of FI management in a semi structured interview, selected others from 12 investigator-identified goals, and rated their importance. Five thematic categories emerged from the 114 participant-identified goal statements: Fecal Incontinence/Bowel Pattern, Lifestyle, Emotional Responses, Adverse Effects of Fecal Incontinence, and Self-Care Practices. Participants selected a median of seven investigator-identified goals (range = 2 to 12). Goals selected by the most participants were decreased number of leaks of stool and greater confidence in controlling fecal incontinence. These goals also had the highest importance along with decreased leakage of loose or liquid stool. The type and number of management goals identified by participants offer a toolbox of options from which to focus therapy when cure is not possible and promote patient satisfaction

Stress, Burnout, Compassion Fatigue, and Mental Health in Hospice Workers in Minnesota

Background: Working in hospice care is a highly challenging yet rewarding profession. However, the challenges of working with dying patients and their families can overwhelm even the most highly dedicated professional, leading to burnout, compassion fatigue, anxiety, and depression. Objective: The aim of this study was to better understand how stress affects the mental health of hospice workers in terms of burnout and compassion fatigue and how they cope with these issues. Methods: Data for this study are from Compassion Fatigue and You, a cross-sectional survey of hospice staff from across Minnesota. We surveyed 547 hospice workers throughout Minnesota to better understand the overall mental health of staff, including levels of stress, burnout, and compassion fatigue, and how they cope with these issues. The study was conducted in 2008 and 2009 through a private, not-for-profit research institute affiliated with a large Midwestern health plan. Results: Hospice staff reported high levels of stress, with a small but significant proportion reporting moderate-to-severe symptoms of depression, anxiety, compassion fatigue, and burnout. Staff reported managing their stress through physical activity and social support, and they suggested that more opportunities to connect with coworkers and to exercise could help decrease staff burnout. Conclusions: Poor mental health places staff at risk for burnout and likely contributes to staff leaving hospice care; this is a critical issue as the profession attempts to attract new staff to meet the expanding demands for hospice care

Effects of Paroxetine and Sertraline on Low-Density Lipoprotein Cholesterol: An Observational Cohort Study

Background: Antidepressant use in US adults increased 3-fold from 2.5% in 1988–94 to 8.1% in 1999–2002, based on National Health and Nutrition Examination Surveys. As the use of antidepressants increases, a comprehensive understanding of the potential health risks that may be associated with their use becomes increasingly important. Objective: This study evaluated the effects of paroxetine and sertraline on low-density lipoprotein cholesterol (LDL-C). Study Design: An observational cohort study (1997–2004) of adults who had taken paroxetine or sertraline for at least 60 continuous days and had ≥2 LDL-C values measured during the study period, one while taking and one while not taking paroxetine or sertraline. A total of 13 634 LDL-C values clustered within 2682 patients were studied. Methods: We conducted mixed model regression analyses to quantify the relationship between antidepressant use and LDL-C values. Results: The number of days taking paroxetine (β = 0.0045; 95% CI 0.0018, 0.0073) and sertraline (β = 0.0074; 95% CI 0.0054, 0.0093) prior to the LDL-C test were related to higher LDL-C values, after accounting for age, sex, year LDL-C was tested, co-morbidity, depression and lipid medication. The number of days that had passed since exposure to paroxetine (β =−0.0013; 95% CI −0.0020, −0.00061) or sertraline (β = −0.00093; 95% CI −0.016, −0.00022) were related to lower LDL-C values. The significant interaction between exposure to an antidepressant and taking a lipid medication demonstrates that the increase in LDL-C values associated with antidepressant use is ameliorated among patients who were taking a lipid medication when LDL-C was measured. Conclusion: Our study showed that long-term use of paroxetine or sertraline may have a measurable adverse impact on cardiovascular risk in adults. Clinical strategies should be used to address cardiovascular risk while maintaining effective treatment of major depression. In light of these findings, attention to LDL-C values should accompany antidepressant use

Mindfulness-Based Stress Reduction for Family Caregivers: A Randomized Controlled Trial

Purpose: Caring for a family member with dementia is associated with chronic stress, which can have significant deleterious effects on caregivers. The purpose of the Balance Study was to compare a mindfulness-based stress reduction (MBSR) intervention to a community caregiver education and support (CCES) intervention for family caregivers of people with dementia. Design and Methods: We randomly assigned 78 family caregivers to an MBSR or a CCES intervention, matched for time and attention. Study participants attended 8 weekly intervention sessions and participated in home-based practice. Surveys were completed at baseline, postintervention, and at 6 months. Participants were 32- to 82-year-old predominately non-Hispanic White women caring for a parent with dementia. Results: MBSR was more effective at improving overall mental health, reducing stress, and decreasing depression than CCES. Both interventions improved caregiver mental health and were similarly effective at improving anxiety, social support, and burden. Implications: MBSR could reduce stress and improve mental health in caregivers of family members with dementia residing in the community

Recruiting and Retaining Family Caregivers to a Randomized Controlled Trial on Mindfulness-Based Stress Reduction

Caregivers for a family member with dementia experience chronic long-term stress that may benefit from new complementary therapies such as mindfulness-based stress reduction. Little is known however, about the challenges of recruiting and retaining family caregivers to research on mind–body based complementary therapies. Our pilot study is the first of its kind to successfully recruit caregivers for a family member with dementia to a randomized controlled pilot study of mindfulness-based stress reduction. The study used an array of recruitment strategies and techniques that were tailored to fit the unique features of our recruitment sources and employed retention strategies that placed high value on establishing early and ongoing communication with potential participants. Innovative recruitment methods including conducting outreach to health plan members and generating press coverage were combined with standard methods of community outreach and paid advertising. We were successful in exceeding our recruitment goal and retained 92% of the study participants at post-intervention (2 months) and 90% at 6 months. Recruitment and retention for family caregiver interventions employing mind–body based complementary therapies can be successful despite many challenges. Barriers include cultural perceptions about the use and benefit of complementary therapies, cultural differences with how the role of family caregiver is perceived, the use of group-based designs requiring significant time commitment by participants, and travel and respite care needs for busy family caregivers

Assessing Organizational Readiness for Depression Care Quality Improvement: Relative Commitment and Implementation Capability

Background: Depression is a major cause of morbidity and cost in primary care patient populations. Successful depression improvement models, however, are complex. Based on organizational readiness theory, a practice’s commitment to change and its capability to carry out the change are both important predictors of initiating improvement. We empirically explored the links between relative commitment (i.e., the intention to move forward within the following year) and implementation capability. Methods: The DIAMOND initiative administered organizational surveys to medical and quality improvement leaders from each of 83 primary care practices in Minnesota. Surveys preceded initiation of activities directed at implementation of a collaborative care model for improving depression care. To assess implementation capability, we developed composites of survey items for five types of organizational factors postulated to be collaborative care barriers and facilitators. To assess relative commitment for each practice, we averaged leader ratings on an identical survey question assessing practice priorities. We used multivariable regression analyses to assess the extent to which implementation capability predicted relative commitment. We explored whether relative commitment or implementation capability measures were associated with earlier initiation of DIAMOND improvements. Results: All five implementation capability measures independently predicted practice leaders’ relative commitment to improving depression care in the following year. These included the following: quality improvement culture and attitudes (p = 0.003), depression culture and attitudes (p \u3c0.001), prior depression quality improvement activities (p \u3c0.001), advanced access and tracking capabilities (p = 0.03), and depression collaborative care features in place (p = 0.03). Higher relative commitment (p = 0.002) and prior depression quality improvement activities appeared to be associated with earlier participation in the DIAMOND initiative. Conclusions: The study supports the concept of organizational readiness to improve quality of care and the use of practice leader surveys to assess it. Practice leaders’ relative commitment to depression care improvement may be a useful measure of the likelihood that a practice is ready to initiate evidence-based depression care changes. A comprehensive organizational assessment of implementation capability for depression care improvement may identify specific barriers or facilitators to readiness that require targeted attention from implementers

Barriers to Improving Primary Care of Depression: Perspectives of Medical Group Leaders

Using clinical trials, researchers have demonstrated effective methods for treating depression in primary care, but improvements based on these trials are not being implemented. This might be because these improvements require more systematic organizational changes than can be made by individual physicians. We interviewed 82 physicians and administrative leaders of 41 medical groups to learn what is preventing those organizational changes. The identified barriers to improving care included external contextual problems (reimbursement, scarce resources, and access to/communication with specialty mental health), individual attitudes (physician and patient resistance), and internal care process barriers (organizational and condition complexity, difficulty standardizing and measuring care). Although many of these barriers are challenging, we can overcome them by setting clear priorities for change and allocating adequate resources. We must improve primary care of depression if we are to reduce its enormous adverse social and economic impacts

Clinician Burnout and Satisfaction with Resources in Caring for Complex Patients

Objective: To describe primary care clinicians\u27 self-reported satisfaction, burnout and barriers for treating complex patients. Methods: We conducted a survey of 1554 primary care clinicians in 172 primary care clinics in 18 health care systems across 8 states prior to the implementation of a collaborative model of care for patients with depression and diabetes and/or cardiovascular disease. Results: Of the clinicians who responded to the survey (n=709; 46%), we found that a substantial minority (31%) were experiencing burnout that was associated with lower career satisfaction (P\u3c.0001) and lower satisfaction with resources to treat complex patients (P\u3c.0001). Less than 50% of clinicians rated their ability to treat complex patients as very good to excellent with 21% rating their ability as fair to poor. The majority of clinicians (72%) thought that a collaborative model of care would be very helpful for treating complex patients. Conclusions: Burnout remains a problem for primary care clinicians and is associated with low job satisfaction and low satisfaction with resources to treat complex patients. A collaborative care model for patients with mental and physical health problems may provide the resources needed to improve the quality of care for these patients

Health Care Charges Associated With Physical Inactivity, Overweight, and Obesity

INTRODUCTION: Physical inactivity, overweight, and obesity are associated with increased morbidity and mortality. The objective of this study was to estimate the proportion of total health care charges associated with physical inactivity, overweight, and obesity among U.S. populations aged 40 years and older. METHODS: A predictive model of health care charges was developed using data from a cohort of 8000 health plan members aged 40 and older. Model cells were defined by physical activity status, body mass index, age, sex, smoking status, and selected chronic diseases. Total health care charges were estimated by multiplying the percentage of the population in each cell by the predicted charges per cell. Counterfactual estimates were computed by reclassifying all individuals as physically active and of normal weight while leaving other characteristics unchanged. Charges associated with physical inactivity, overweight, and obesity were computed as the difference between current risk profile total charges and counterfactual total charges. National population percentage estimates were derived from the National Health Interview Survey; those estimates were multiplied by the predicted charges per cell from the health plan analysis. RESULTS: Physical inactivity, overweight, and obesity were associated with 23% (95% confidence interval [CI], 10%–34%) of health plan health care charges and 27% (95% CI, 10%–37%) of national health care charges. Although charges associated with these risk factors were highest for the oldest group (aged 65 years and older) and for individuals with chronic conditions, nearly half of aggregate charges were generated from the group aged 40 to 64 years without chronic disease. CONCLUSION: Charges associated with physical inactivity, overweight, and obesity constitute a significant portion of total medical expenditures. The results underscore the importance of addressing these risk factors in all segments of the population